A infecção pelo Papilomavírus Humano (HPV) é a principal responsável pelo desenvolvimento de lesões intraepiteliais e, potencialmente, do câncer cervical (CC). A presença de fatores como inflamação e outros agentes infecciosos contribuem para a instalação e persistência do vírus. A inclusão da pesquisa do HPV e de outros agentes infecciosos relacionados junto a programas de rastreamento do CC ainda é controversa. Além disso, sabe-se que o processo inflamatório e as lesões celulares decorrentes da presença de HPV e seus cofatores provocam alterações na expressão de diversas proteínas, entre elas a S100A4, que poderia funcionar como biomarcador de exposição. Desta forma, foram analisadas amostras de esfregaços cervicais para investigação da relação do diagnóstico citológico com a presença de agentes infecciosos, além do padrão de expressão da proteína S100A4. Nossos resultados demonstraram que o aparecimento de lesões ou atipias citológicas apresentou associação com a presença de HPV, tanto na infecção simples como na infecção por múltiplos genótipos de alto risco oncogênico, sugerindo a pesquisa molecular do HPV complementar à citologia. A presença de infecção latente pelo HPV também foi observada, a qual deve ser acompanhada com exames citológicos periódicos. A infecção por Chlamydia trachomatis desempenha importante papel como cofator para o desenvolvimento do CC e foi prevalente na população estudada, demonstrando associação com a presença de diferentes genótipos de HPV. Tanto nas pacientes sintomáticas como nas assintomáticas houve a detecção de leveduras do gênero Candida, sendo que a mais prevalente foi a C. albicans apresentando-se sensível à Anidulafungina e Anfotericina B, na maioria dos casos, e resistente ao Fluconazol. Com relação à expressão da proteína S100A4, houve associação com as alterações citológicas características do HPV, nas quais houve redução de sua expressão à medida que aumentou o grau da lesão. No entanto, também observamos que há expressão fisiológica da proteína S100A4 no epitélio escamoso estratificado da ectocérvice que varia de acordo com o grau de maturação celular e a presença de alterações citológicas inflamatórias, onde foi demonstrado aumento da sua expressão. Portanto, a avaliação da expressão da proteína S100A4 pode auxiliar no diagnóstico precoce do câncer de colo do útero nas lesões intraepiteliais cervicais positivas para HPV. Analisando-se globalmente, estes resultados sugerem a inclusão da pesquisa molecular de HPV e C. trachomatis, bem como a identificação de leveduras do gênero Candida complementares à citologia esfoliativa junto a programas de rastreamento. Além disso, a proteína S100A4, mostrou-se promissora como biomarcador dos efeitos celulares dos fatores associados. Observa-se que a associação de diferentes metodologias permite a detecção precoce de lesões e, consequentemente, contribuem para a redução da incidência do CC. / Human papillomavirus (HPV) infection is the main responsible for the development of intraepithelial lesions and potentially cervical cancer (CC). The presence of factors such as inflammation and other infectious agents contribute to the onset and persistence of the virus. The inclusion of HPV research and other infectious agents associated in the CC screening programs is still controversial. In addition, it is known that inflammation and cell injury caused by the presence of HPV and their cofactors cause changes in gene expression and function of several proteins, including the S100A4 which could function as a biomarker of exposure. Thereby, samples of cervical specimens were analyzed to investigate the relationship of cytological diagnosis in the presence of infectious agents, other than the standard expression of S100A4 protein. Our results demonstrated that the development of lesions or cytological atypia was associated with the presence of HPV in either simple infection or infection by multiple genotypes of high oncogenic risk, indicating the importance of molecular HPV analysis complementary to cytology. The presence of latent infection was also observed and must be monitored with periodic cytological examinations. The Chlamydia trachomatis infection plays an important role as a cofactor for the development of CC and was prevalent in the population studied, demonstrating association with the presence of different HPV genotypes. For both symptomatic and asymptomatic patients there was a yeast detection of Candida, and the most prevalent was the Candida albicans presenting sensitive to Anidulafungin and Amphotericin B, in most cases, and resistant Fluconazole. Regarding the S100A4 protein expression, there was association with abnormal cytological HPV characteristics where a reduction of expression could be observed and the degree of injury increased. However, we also observed that there are physiological expression of S100A4 protein in the stratified squamous epithelium of the ectocervix and this varies according to the degree of cell maturation and the presence of inflammatory cell alterations, increased expression where demonstrated. Therefore, the evaluation of the expression of S100A4 protein may assist in the early diagnosis of cervical cancer in cervical intraepithelial lesions positive for HPV. Overall, these results suggest the inclusion of molecular research of HPV and C. trachomatis, and the identification of yeasts Candida complementary to exfoliative cytology in screening programs. In addition, the S100A4 protein has shown to be promising as a biomarker for cellular effects of associated factors. It was observed that the association of different methodologies allows early detection of lesions and therefore contribute to reducing the incidence of CC.

abstract: Extraordinary medical advances have led to significant reductions in the burden of infectious diseases in humans. However, infectious diseases still account for more than 13 million annual deaths. This large burden is partly due to some pathogens having found suitable conditions to emerge and spread in denser and more connected host populations, and others having evolved to escape the pressures imposed by the rampant use of antimicrobials. It is then critical to improve our understanding of how diseases spread in these modern landscapes, characterized by new host population structures and socio-economic environments, as well as containment measures such as the deployment of drugs. Thus, the motivation of this dissertation is two-fold. First, we study, using both data-driven and modeling approaches, the the spread of infectious diseases in urban areas. As a case study, we use confirmed-cases data on sexually transmitted diseases (STDs) in the United States to assess the conduciveness of population size of urban areas and their socio-economic characteristics as predictors of STD incidence. We find that the scaling of STD incidence in cities is superlinear, and that the percent of African-Americans residing in cities largely determines these statistical patterns. Since disparities in access to health care are often exacerbated in urban areas, within this project we also develop two modeling frameworks to study the effect of health care disparities on epidemic outcomes. Discrepant results between the two approaches indicate that knowledge of the shape of the recovery period distribution, not just its mean and variance, is key for assessing the epidemiological impact of inequalities. The second project proposes to study, from a modeling perspective, the spread of drug resistance in human populations featuring vital dynamics, stochasticity and contact structure. We derive effective treatment regimes that minimize both the overall disease burden and the spread of resistance. Additionally, targeted treatment in structured host populations may lead to higher levels of drug resistance, and if drug-resistant strains are compensated, they can spread widely even when the wild-type strain is below its epidemic threshold. / Dissertation/Thesis / Ph.D. Applied Mathematics for the Life and Social Sciences 2014

Introdução: Os homens biológicos profissionais do sexo (male sex workers MSW) constituem uma população heterogênea, de forma que uma classificação tipológica poderá promover o desenvolvimento de políticas públicas mais específicas. Embora existam diversas classificações para o homem que se prostitui nas ruas das cidades (street hustlers), há poucos estudos que avaliam aspectos psicopatológicos específicos desses indivíduos. Este estudo examina aspectos dimensionais da personalidade, impulsividade, uso de álcool e drogas e envolvimento com atividades criminais entre street hustlers da cidade de Santo André/SP. Método: Trata-se de um estudo seccional e retrospectivo, realizado pelo Ambulatório de Transtornos da Sexualidade da Faculdade de Medicina do ABC (ABSex), em associação com o Grupo Interdisciplinar de Estudos de Álcool e Drogas do Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo (GREA Ipq FMUSP). Oitenta e seis sujeitos foram avaliados por meio de questionários autoresponsivos, sendo as entrevistas realizadas nas ruas de Santo André/SP, no próprio local de trabalho dos entrevistados, entre 2008 e 2010. Resultados: MSW portadores de transtornos de identidade de gênero (TIG) apresentaram maiores níveis de Esquiva ao Dano, mais frequente história de agressão física por parte dos clientes e menor oportunidade de outros empregos quando comparados com MSW sem TIG. MSW com uso inconsistente de preservativos apresentaram mais problemas com uso de álcool e drogas, maiores níveis de Dependência de Gratificação, mais frequente história de tentativas prévias de suicídio e antecedente criminal quando comparados a MSW com uso consistente de preservativos. Conclusões: A prostituição masculina é um fenômeno composto de múltiplos aspectos. Há múltiplas variações em termos de motivações e padrões de vida entre os MSW, de forma ser necessário dividi-los em categorias. A identidade e papel de gênero, uso de substâncias psicoativas e aspectos de personalidade são variáveis importantes a serem consideradas quando do desenvolvimento de políticas de saúde pública mais específicas. A habilidade em avaliar tais características pode ser ferramenta importante no desenvolvimento de propostas mais efetivas para o manejo dessa complexa população / Introduction: Male sex workers (MSW) are a heterogeneous population, and researchers aim to categorize them into typology groups to develop more specific public health policies. Although there are several classifications for MSW who work on streets (street hustlers), there are few studies that evaluate specific psychopathology aspects of these individuals. This study examines the dimensional aspects of personality, impulsiveness, alcohol and drug use, and criminal history among street hustlers in the city of Santo André/SP. Method: This is a cross-sectional and retrospective study, carried out by Ambulatory for the Treatment of Sexual Disorders of ABC Medical School (ABSex), in association with the Interdisciplinary Group of Studies on Alcohol and Drugs, Psychiatry Institute Faculty of Medicine - São Paulo University (GREA - IPQ - FMUSP). Eighty-six subjects were assessed through self-report questionnaires. The interviews were performed on the streets of Santo André/SP, in the workplace of the MSW, from 2008 to 2010. Results: MSW with gender identity disorder (GID) showed higher Harm Avoidance levels, more frequent history of physical aggression by clients and less opportunity of other jobs when compared with street MSW without GID. MSW with inconsistent condom use showed more alcohol and drug use problems, higher levels of Reward Dependence, higher frequency of personal history of suicide attempts and criminal history. Conclusions: Male prostitution is a phenomenon composed of multiple aspects. Variations of personal motivations and life patterns among MSW are huge. So it is necessary to divide them into clusters. Identity and gender roles, substance abuse, personality aspects, like Harm Avoidance and Reward Dependence, are important variables to be considered for the development of more specific public health policies. The ability to assess such characteristics may be an important tool in developing proposals for more effective management of this complex population

Philosophiae Doctor - PhD / Sexually transmitted infections (STIs) are a problem for both developed and developing countries. Sub-Saharan Africa has the highest rates in the 15-49 years old group. The discovery that these infections playa vital role in the transmission of HIV raised their profile and made their control one of the central strategies of stopping the HIV/AIDS epidemic. In response to the challenge of improving the quality of care for people infected with STIs in the public health sector, the South African Ministry of Health adopted the syndromic management approach, recommended by the World Health Organisation as suitable for resource-poor settings, for use in primary health care clinics. In addition to providing guidelines on clinical management of STIs, the syndromic approach requires health providers to counsel and educate patients about STIs, encourage patients to complete treatment even if symptoms abate, promote condom use and the treatment of all sexual partners. While the management guidelines are clear and detailed around the diagnostic and medication issues, the processes of education and counseling are not as clearly outlined. Furthermore, although the syndromic approach is a viable way of providing good quality care to larger sections of the population than could be serviced through dedicated STI clinics, it requires health providers working in primary health care clinics, most of whom are professional nurses, to perform some tasks for which they may not be adequately trained. This study evaluated the quality of care for persons infected with ST!s by examining the extent to which the syndromic approach was being implemented in primary health care clinics. Interviews, using semi-structured interview schedules, were conducted with ST! patients and health providers in twenty-four clinics located in four provinces. In depth qualitative interviews were also conducted with a sub-sample of the patients. For further triangulation the methods of participant observation, through the use of simulated patients, and focus group discussions with various community groups were used. The findings of the study indicate that although primary health care clinics in South Africa are well-resourced, the management of patients with ST!s is inadequate. Adherence to the various aspects of syndromic management was poor. Similar to other studies in South Africa, the attitudes of health providers towards patients with ST!s were found to be problematic, a finding that has implications for health-seeking behaviours. The thesis argues that a large part of the problem is related to the multiple roles that nurses have to play in primary health care settings, as well as the content and methodology of the training of nurses who manage ST! patients. It further argues for the constitution of the basic health team at primary health clinics to be multi-disciplinary, and for a multi-disciplinary input in the training of health providers.

Submitted in partial requirements for the degree of Doctor of Philosophy in the Department of IsiZulu namaGugu in the Faculty of Arts at the University of Zululand, 2002. / Lolu cwaningo lucubungula ulwazi lwesintu, amasiko, izinkolelo nemikhutshana yesizwe samaZulu neqhaza okungalibamba ekugwemeni izifo ezithathelwana ngokocansi, ikakhulukazi igciwane lesandulela ngculazi nengculazi uqobo lwayo. Luzama ukuthola ukuthi qhaza lini elingabanjwa umphakathi ekulweni nalesi sifo esesibhubhise izwe kangaka. Lucubungula izindlela zesintu ezazisetshenziswa ngempumelelo, esikhathini sakudala, ukunqanda izifo ezithathelwana ngokocansi. Luzama ukuthola ukuthi lezo zindlela ngeke yml zakhuthazwa ukuba zisetshenziswe esikhathini sanamuhla njengesikhali okungaliwa ngaso nalesi sifo esesiqede isizwe Lucubungula iqhaza elingabanjwa amasiko afana nokusokwa kwabesilisa nabesifazane, ukugwetshwa kwabesilisa nabesifazane, ukuhlolwa kwezintombi nezinsizwa, ukuthomba, ukusoma, ukuyobisa, umemulo, irnikhosi efana nomkhosi kaNomkhubulwane, umkhosi womhlanga, kanye neqhaza elingabanjwa amabandla ehlukene ekulweni nokusabalala kwegciwane lesandulela ngculazi, ingculazi uqobo lwayo, ezinye izifo ezithathelwana ngokocansi, ukukhulelwa kwentsha isikhathi singakafiki kanye nokufundiswa kwentsha ngokuziphatha ngenhlanzeko.

Sexually transmitted infections (STIs) are a common health problem in all populations; however, female adolescents are at increased risk for acquiring STIs and their complications. Their increased risk of acquiring STIs is due to their behavior, anatomy. and lack of knowledge about STIs. STIs have many complications in women. Some complications include: pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility. The purpose of this integrative review is to identify current sexual behaviors of female adolescents, and to find strategies at preventing or reducing STIs within this population. Nurses and other health care providers need to know the current statistics of STIs in adolescent females, and need to understand their current sexual behaviors in order to implement effective preventative strategies.

The Navajo tribe reports extraordinarily high number of cases of sexually transmitted diseases (STDs), such as gonorrhea, chlamydia, and human immunodeficiency virus (HIV) among men who have sex with men (MSM) and heterosexual populations. The purpose of this qualitative study was to explore the cultural value of adil' idli (self-respect) and how this cultural practice might influence health behaviors in sexual activity, condoms use, and acquiring of STDs among Navajo men. The Health Belief Model (HBM) was the theoretical foundation for providing a deeper understanding of the social, environmental, and cultural factors of condom use among Navajo men. Research questions focus on understanding whether condoms affected sexual activity, its protective role against STDs/HIV, and acceptability concerns pertaining to adil' idli (self-respect). A purposeful criterion-based sampling was used to select and interview 20 Navajo men ages 20 to 39 who lived in or near Shiprock, New Mexico and Gallup, New Mexico. I used a grounded approach and categorizing strategy to code and analyze the transcripts. Key findings revealed that the positive components of adil' idli (self-respect) have influenced Navajo men to protect themselves by wearing condoms. Recommendations include identifying strategies to address condom errors and failures and to develop tactful approaches to promote correct condom use in order to decrease the rates of STDs and HIV among Navajo men. The positive social change implications include health professionals' use of findings to improve STD and condom use prevention behavior among Navajo men by integrating the cultural beliefs of adil' idli (self-respect), specifically emphasizing the positive aspects of staying healthy in health messages.

My theses deal with evaluation of the level of cooperation among chosen medical facilities and organs protecting public health (OOVZ) in the area of detection and reporting some of sexually transmitted diseases (STD) in Strakonice region. The main objective was to characterize the quality of this cooperation on the basis of an analysis of laboratory-proven, clinically confirmed, reported and then demonstrated cases of STDs. It concerned chlamydial infections, urogenital diseases caused by mycoplasma, syphilis and gonococcal infections in 2005 - 2011. Research data were obtained from the microbiology laboratory information system of the Central Laboratories of Hospital Strakonice, Inc. Then all the medical facilities of the surrounding area, which took biological material and sent it for examination to the microbiological laboratory of Hospital Strakonice, were contacted. In qualitative research two research questions were formulated: whether the laboratory-positive cases of selected sexually transmitted diseases are also confirmed clinically and whether the laboratory and clinically confirmed diseases are reported in all cases to OOVZ and assigned in health information systems services. All positive laboratory findings were also verified and confirmed clinically. The research proved that in all cases were reported classical sexually transmitted infections (syphilis and gonorrhea). The established system of cooperation between microbiological laboratories, national reference laboratories, dermatovenerological consultant, venereological screening nurse and the Public Health Service is very functional. In contrast, other selected sexually transmitted diseases, which are diagnosed by specialists other than dermatovenerologists, are reported in fewer cases.

Despite the ongoing investments in programs to increase sexual health awareness among young adults globally, many youths remain vulnerable to sexually transmitted diseases (STDs). Two-thirds of all STDs occur among youths engaging in high-risk sexual behaviors, which put young adults at higher risk of STDs and can result in serious consequences including infertility. Additionally, the social consequences of STD affect families and communities. While a need exists for increased public awareness of STDs among young adults, extant intervention and prevention activities should be informed by a cultural perspective, including the integration of community and government roles. The purpose of this social ecological study was to investigate the perceptions of STDs and the potential factors responsible for the increased frequency of STDs based on the lived experiences of 20 young adults with STDs in Akwa Ibom State, Nigeria. Through a qualitative approach using a phenomenological research design, this study employed semi-structured interviews, and the resultant data were analyzed and coded. The findings indicated that college-aged students increasingly engaged in sexually risky behavior with multiple sexual partners for financial gain and power. Additionally, while institutions promoted abstinence as an effective strategy to reduce STD infections, the findings indicated a strong relationship between the phenomenon and individual interconnectedness with the larger society. Because the sexual behavior of young adults in Akwa Ibom State, Nigeria, is influenced at multiple ecological levels, effective and sustaining culturally appropriate STD interventions must involve the larger society including young adults in all stages of intervention development and implementation.

No description available.